Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | WI |
NPI | 1003395211 |
---|---|
Provider Name | Ms. Sarah Fajardo |
First Address | Woodland Hills, CA 91367-7807 |
Second Address | Brown Deer, WI 53209-1550 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2018 |
Last Update Date | 11/09/2018 |